Nursing attitude toward patient safety in

emergency departments in Jazan

Submitted In Partial Fulfillment of Master Degree in

Nursing Administration

By
Sawsan Mohammed Homadi 443815307
Maliha Mohmmad Mangari 443815187
Amnah Abdulrhman Otayf 443815177
Afrah Muhammad Gomiri 443815191
Fatema Hussein Mahzari 443815165
Eman Qasem Al haffaf 443815156

Supervisors
Enas Mohammed Basioni

Lecturer of Nursing Administration

Faculty of Nursing
King Khalid University

Faculty of Nursing
2022
Table of Contents
Abstract ......................................................................................................................2
Introduction ................................................................................................................3
Significance ................................................................................................................6
Literature Review .......................................................................................................7
Aim of the study .........................................................................................................9
Subjects & Methods .................................................................................................10
Technical design: .............................................................................................. 10
Research design: ............................................................................................... 10
Setting: ............................................................................................................. 10
Sample: ............................................................................................................. 10
Inclusion criteria: .............................................................................................. 10
Methodology ............................................................................................................11
Administrative design: ...................................................................................... 11
Ethical consideration: ....................................................................................... 11
Statistical design: .............................................................................................. 11
Sample .............................................................................................................. 12
Data collection .................................................................................................. 12
Data analysis ..................................................................................................... 12
RESULT...................................................................................................................13
Introduction:..................................................................................................... 13
Demographic Characteristics of Respondents:.................................................. 13
DISCUSSION ..........................................................................................................21
Introduction:..................................................................................................... 21
Discussion: ........................................................................................................ 21
Conclusion: ..............................................................................................................23
References: ...............................................................................................................25

1
Abstract
Objective: To describes the results of a baseline assessment of the nursing attitude
toward patient safety in the emergency departments of various hospitals in Jazan,
considering the tremendous attention paid to patient safety.

Design: Descriptive correlational design will be conducted to achieve the aim of the
study.

Participants: A total of 102 hospital employees participated in the study including,

nurses and doctors.

Results: respondents were primarily employed in adult and pediatrics ER

Departments. The dimensions with the highest positive ratings were teamwork
within units and organizational learning and continuous improvement, while those
with lowest ratings included staffing number to handle the workload and patient
safety problems alongside supervisor/manager overlooks patient safety problems
that happen over and over.

Conclusions: If hospitals are to increase overall performance and service quality,

they must invest in procedures that boost patient safety. To improve patient safety
practices and culture, a lot of effort needs to be done at the sampled businesses as
well as the region as a whole.

Keywords: patient safety culture, hospitals, emergency department, jazan

2
 Introduction
Healthcare professionals, managers, and policymakers now place a high focus
on patient safety. The key to spreading this idea among medical practitioners and
keeping it alive in healthcare institutions is to establish a strong patient safety
culture.

A robust and supportive patient safety culture is a prerequisite for making

patient safety culture a top priority.

Open communication, teamwork, and an understanding of mutual dependence

are some aspects of a robust patient safety culture.

The first stage in creating a strong and stable safety culture is to evaluate the
patient safety culture of the healthcare institution.

This is reflected in the fact that a growing number of international

accreditation bodies now demand patient safety culture assessments to gauge how
healthcare professionals view issues like teamwork, the steps taken by management
and leadership to support and promote patient safety, staffing issues, the frequency
of incident reporting, and other patient safety culture-related problems.

These evaluations enable healthcare companies to gain a clear understanding

of the areas that need to be improved in order to build their patient safety culture and
to pinpoint specific patient safety concerns within hospitals units, particularly in the
ED unit.

An essential component of providing healthcare is patient safety. Patient

safety initiatives seek to avert mistakes and lessen the chance that patients will
sustain harm while receiving medical care. Healthcare professionals must
continually get training and reinforcement in patient safety procedures in order to
maintain patient safety standards and prevent negative outcomes.

3
 Patient safety is "the act of avoiding, preventing or improving undesirable
outcomes or injuries experienced along the medical-hospital process," according to
the International Classification for Patient Safety (ICPS). The World Health
Organization (WHO) claims that adverse medical events are one of the main causes
of hospitalized patients' death and disability. According to the WHO, "patient safety"
is defined as the elimination of any avoidable risks to patients' health. (World Health
Organization, 2019)

Healthcare systems all throughout the world are impacted by medical errors.
Worldwide, the cost of medical errors is estimated to be USD 42 billion per year.
(Aitken M, 2012)

According to research, medical errors are the third leading cause of death in
the USA, accounting for over 250,000 fatalities annually. (Makary MA, 2016)

However, 2.6 million of the 134 million adverse events that occur in hospitals
each year in low- and middle-income countries result in fatalities. Medical errors
and adverse events related to health care occur in 8–12% of hospitalizations,
according to analyses of European data, primarily from Denmark, France, and Spain.
(World Health Organization, 2019)

According to an OECD report, 15% of hospital operational expenses go

toward treating adverse events. (OECD, 2017)

So, the health of patients may be improved, and healthcare organizations and
national health systems may save money as a result of measures targeted at reducing
the causes of bad events that happen while a patient is hospitalized. (Slawomirski L,
2017)

When establishing a workplace where patient safety is a top priority, Hughes

et al. stressed the significance of staff members' attitudes. (Hughes LC, 2009)

4
 To improve patient care and safety, it is essential to comprehend how medical
staff members feel about the variables influencing patient safety. The settings that
encourage changes in staff behaviour, which could make the healthcare environment
safer, are created by analysing the elements that contribute to the occurrence of
adverse occurrences. (de Vries EN, 2008)

The danger of staff errors is reduced by standardised systems with rules and
procedures focused on patient safety for both the direct care staff and their
management. (Ikwueme, 2018)

Additionally, one crucial aspect of promoting organizational change to

enhance patient safety is the use of tools like the Safety Attitudes Questionnaire for
evaluating healthcare worker attitudes regarding patient safety at the organizational
level. (Alzahrani N, 2019)

It is also important to keep in mind that a patient's safety while receiving

treatment is inextricably linked to the actions of everyone involved in providing it,
including nurses, doctors, and administrators. High levels of occupational safety
awareness, interdisciplinary teamwork, evaluation of the work safety culture, as well
as analysis and conclusion drawing, can improve quality and safety in practice and
make patients feel safer.

However, it should be kept in mind that a safety culture is crucial for

establishing a safe working environment for healthcare personnel as well as for
lowering the risk of injury to hospitalized patients.

Researching healthcare personnel' attitudes toward patient safety is the first

step in creating safety cultures.

5
 Significance
A strong and positive patient safety culture can be predicted by a number of
factors, including communication, information flow between and across units, a
shared understanding of the significance of patient safety, steadfast and ongoing
commitment from management and leadership, and a non-punitive approach to
incident and error reporting, according to evidence in the literature. (Sanders J, 2007)

The lierature on patient safety culture is scarce in the Arab world, and the
Kingdom of Saudi Arabia (KSA) in particular, despite the abundance of evidence
that has been published in recent years.
Organizational learning was found to be the most beneficial feature of patient
safety culture in both public and private hospitals, whereas non-punitive response to
error was found to be its weakest component, according to a prior study carried out
in Riyadh in 2009. (Al-Ahmadi, 2009)

6
 Literature Review
Surveying 6807 hospital personnel across 68 institutions in Lebanon allowed
researchers to delve into the topic of patient safety culture. The study used an Arabic
version of the HSOPSC to determine the most important problems with patient
safety culture and possible solutions for putting the patient safety accreditation
criteria into practice. Teamwork within units, hospital management support for
patient safety, organizational learning, and continuous improvement were all cited
as areas of strength by the selected respondents. Areas of weakness, however, were
cross-hospital collaboration, hospital handoffs and transitions, staffing, and error-
response without repercussion. (El-Jardali F, 2010)

Over 70% of respondents gave their units an "Excellent/Very Good" patient

safety score, and about 60% said they had not completed any event reports in the
previous 12 months.

All patient safety composite scores were combined and regressed against
respondent traits. Longer years of experience, working as a nurse or pharmacist,
interacting with patients, and working at a hospital with accreditation were all linked
to a higher overall score. (El-Jardali F, 2010)

To determine patient safety culture predictors and results, a follow-up study

was carried out. Higher scores on supervisor/manager expectations, organisational
learning and continuous improvement, hospital unit teamwork, feedback and
communication about errors, staffing, and hospital management support for patient
safety and hospital handoffs and transitions were all linked to better patient safety
grades. It was discovered that event reporting was linked to lower scores on hospital
handoffs and transition and higher scores on feedback and communication about
mistakes.

7
 Higher scores on organizational learning and continuous improvement,
communication and openness, feedback and communication, non-punitive response
to errors, hospital management support for patient safety, and teamwork within
hospital units were all related to the frequency of event reporting.

Higher ratings for supervisor/manager expectations and actions promoting

safety, organizational learning and continuous improvement, teamwork within
hospital units, non-punitive response to error, hospital management support for
patient safety, and hospital handoffs and transitions were linked to better overall
perceptions of patient safety. (El-Jardali F D. H., 2011)

8
 Aim of the study
Strong leadership is required for a patient safety program to succeed. Only senior
leaders have the ability to build the culture and commitment required to address the
root causes of medical errors and patient damage. The entire organization will adopt
a culture of safety if the leadership and management are dedicated to doing so,
making it an organizational process to disclose bad incidents and identify their
causes.

Emergency departments, surgical rooms, and intensive care units should be the
focus. So, the aim of this study is to assess Patient safety culture and nurses’ attitude
towards them in ED unit, through the following objectives:

- To describes the results of a baseline assessment of the nursing attitude toward

patient safety in the emergency departments of various hospitals in Jazan
(King Fahd Hospital, Prince Muhammad Bin Nasser Hospital, Abu Arish
General Hospital, Al-Twal Hospital, and other hospitals), considering the
tremendous attention paid to patient safety.
- To describe nurses’ attitude toward patient safety in emergency departments
and discuss patient safety culture.

Research questions:
1- Does the hospital management provide a work environment that enhances
patient safety?
2- In those hospitals, is information about event reports used to ensure the patient
safety?
3- what is the knowledge and skills nurses have in relation to patient safety?
4- In those hospitals, is patient safety always considered as priority‫؟‬
5- Are there any comments and communications about bugs?
6- Are the respondents' safety trends positive?
7- How is the openness of communication?
8- How is the Overall perception of safety?

9
 Subjects & Methods
Subjects and methods of the study will be consisted of four main designs as follows:
technical, operational, administrative and statistical designs.

Technical design:
The technical design of this study will include a description of the research design,
the research setting, the subject, and tools of data collection (HSOPSC).

Research design:
Descriptive correlational design will be conducted to achieve the aim of the study.

Setting:
This study will be conducted at multiple hospitals in jazan (King Fahd Hospital,
Prince Muhammad Bin Nasser Hospital, Abu Arish General Hospital, Al-Twal
Hospital, and other hospitals).

Sample:
All nurses in the emergency medical unit at the time of data collection.

Inclusion criteria:
Inclusion criteria for this study sample include:

- Nurses and doctors who accept to participate in the study (Saudi, Non-Saudi)
- Nurses and doctors who had been in the profession for less than 6 moths and
more than 21years.

10
Methodology
Study Design: The study is about Nursing attitude toward patient safety in
emergency departments in jazan in ksa.
Study area: jazan in ksa.
Study duration: The study was carried out during the months of October and
November of 2022.
Study technique: the descriptive analytical method used to obtain the study data
based on a questionnaire in multi-disciplinary hospitals with Nurses of jazan
hospitals.

Administrative design:
To carry out the study in the selected setting, an official approval for the collection
of the data will be obtained by using the proper channel of communication from the
medical and nursing director of the hospital which is affiliated with the Ministry of
Health after explaining the aim of the study.

Ethical consideration:
Clarification of the nature and aim of the study will be done with each subject.
Written consent will be obtained from the study subjects, the confidentiality of any
obtained information will be insulted, and they will be given an opportunity to refuse
or participate in the study at any time of data collection.

Statistical design:
Data will be collected, analyzed, organized, and tabulated by using appropriate
statistical methods according to the obtained results.
Discussion:
Discussion of the results will be done based on current related literatures.

11
Conclusion and recommendation:
They will be derived from the discussion and results.

Sample
The sample (n=102) of this descriptive study comprised of nurses and doctors
working in multiple hospitals in jazan in ED, Saudi Arabia; these hospitals provide
services for all health disciplines. In total, a sample size of 81 nurse and 19 doctor
was calculated for this study.

Data collection
The researcher developed the questionnaire through google form which includes 31
items on the participant’s sociodemographic features and thoughts on patient safety.
Items included age, gender, nationality, Profession, years in Specialty, ER
Department.

The scale rates answers from 5=strongly agree to 1=strongly disagree. the reliability
Statistics: total Cronbach’s alpha is = 0.953.

Data analysis
Descriptive statistics were used to summarize the data regarding socio-demographic
characteristics and the questionnaire sections. Categorical variables were presented
in frequencies and percentages [number, percentage, mean and standard deviation
(SD)], using SPSS V26.

12
 RESULT
Introduction:
The chapter presents the result of the study according to the four domains mentioned
in the methodology chapter, with reference to the study's objectives.

Demographic Characteristics of Respondents:

Age:
At this study on Nurse and doctor attitude toward patient safety in emergency
departments in Jazan, Saudi Arabia, the study included 102 participants; 37.3% of
them had age ranged between from 31-40 years, 40% From 30 – 35 years, 29.4%
35– 40 years.

Figure 1: Distribution of participants according to age

13
Gender:

Most of the participants were females

Figure 2: Distribution of participants according to gender

The results showed there are 102 participants, 84.3% Saudi and 15.7 non-Saudi,
18.6% doctor and 79.4% nurse, most of them has been working from 11–20 years.
With 65.7% in adult department.

14
15
 Table 1
Distribution of socio-demographical characteristics of nurses & doctors (n=102).

socio-demographic variables N %
Gender
o Male 37 36.3
o Female 65 63.7
Age
o 25 - 30 23 22.5
o 30 - 35 38 37.3
o 35 - 40 3 29.4
o Older 11 10.8
Your Nationality
o Saudi 86 84.3
o non-Saudi 16 15.7
Your Profession
o Doctor 19 18.6
o Nurse 81 79.4
o Missing 2 2.0
Years in Specialty
o < 6 months 8 7.8
o 6–11 months 2 2.0
o 1–2 years 5 4.9
o 1–2 years 11 10.8
o 5–10 years 26 25.5
o 11–20 years 43 42.2
7 6.9
o > 21 years
ER Department
o Adult 67 65.7
o pediatrics 23 22.5
o Maternity 7 6.9
o Missing 5 4.9
How long does the patient usually wait before you speak to them for the first time?
o 0 -15 minutes 65 63.7
o 16 - 30 minutes 18 17.6
o 31- 60 minutes 7 6.9
o More than 60 minutes 6 5.9
o Don’t know/ Can’t remember 5 4.9
o Missing 1 1.0

16
Before giving any new medication, did you describe the possible side effects to the patient in a
way that they could understand?
o Yes 87 85.3
o No 14 13.7
o Missing 1 1.0

Before leaving the emergency room, did you diagnose the patient's major health problem?
o Yes 90 88.2
o No 10 9.8
o Missing 2 2.0

Overall perception of safety

N Mean Std. Deviation
[It is just by chance that more serious mistakes do 97 3.1959 1.22167
not happen around here]

[Patient safety is never sacrificed to get more work 97 3.0722 1.22685

done]

[We have patient safety problems] 97 2.8660 1.17818

[Our policies and procedures and systems are 96 3.3854 1.12736

effective in preventing errors]

Valid N (listwise) 96

Supervisor/Manager expectations & actions promoting patient safety

N Mean Std. Deviation
[My supervisor/manager says a good word when 97 3.2371 1.17945
he/she sees a job done according to established
patient safety procedures]

[My supervisor/manager seriously considers staff 97 3.2165 1.18345

suggestions for improving patient safety]

[Whenever pressure builds up, my 97 2.9278 1.18363

supervisor/manager wants us to work faster, even if
it means taking shortcuts]

17
 [My supervisor/manager overlooks patient safety 97 2.8969 1.14095
problems that happen over and over]

Valid N (listwise) 97

Organizational learning and continuous improvement

N Mean Std. Deviation
[We are actively doing things to improve patient 95 3.6842 1.06455
safety]
[Mistake have led to positive changes here] 95 3.3579 1.04082

[After we make changes to improve patient safety, 95 3.4421 1.12719

we evaluate their effectiveness]
Valid N (listwise) 93

Teamwork within units

N Mean Std. Deviation
Teamwork within units [Staff support one another in 97 3.6701 1.06772
this unit]
[When a lot of work needs to be done quickly, we 97 3.5773 1.05904
work together as a team to get the work done]

[In this unit, people treat each other with respect] 97 3.5876 1.08736

[When members of this unit get really busy, other 97 3.5155 1.11909
members of the same unit help out]

Valid N (listwise) 97

18
 Non-punitive response to error
N Mean Std. Deviation
[Staff feel like their mistakes are held against 97 3.2062 1.01999
them]

[When an event is reported, it feels like the person 97 3.2371 1.01830

is being written up, not the problem]

[Staff worry that mistakes they make are kept in 97 3.4124 1.06803
their personnel file]

Valid N (listwise) 96

Staffing
N Mean Std. Deviation
[We have enough staff to handle the workload] 96 2.4583 1.26422
[Staff in this unit work longer hours than is best for 96 3.2083 1.21323
patient care]
[We use agency/temporary staff than is best for 98 2.9082 1.11306
patient care]
[When the work is in “crisis mode” we try to do too 98 3.4898 1.12374
much, too quickly]
Valid N (listwise) 94

Hospital management support for patient safety

N Mean Std. Deviation
[Hospital management provides a work climate that 98 3.2755 1.12864
promotes patient safety]

[The actions of hospital management show that 98 3.3980 1.13737

patient safety is a top priority]
[Hospital management seems interested in patient 98 3.3163 1.11778
safety only after an adverse event happens]
Valid N (listwise) 98

19
 Communication openness
N Mean Std. Deviation
[Staff will freely speak up if they see something 98 3.2347 1.19967
that may negatively affect patient care]

[Staff feel free to question the decisions or actions 98 3.0612 1.17374

of those with more authority]

[Staff are afraid to ask questions when something 98 2.9490 1.14309

does not feel right]

Valid N (listwise) 98

Feedback and communications about error

N Mean Std. Deviation
[We are given feedback about changes put into 96 3.3438 1.06453
place based on event reports]

[We are informed about errors that happen in this 95 3.4737 1.08021
unit]

[In this unit, we discuss ways to prevent errors 95 3.4211 1.11641

from happening again]

Valid N (listwise) 92

20
 DISCUSSION
Introduction:
In this chapter the results of the study discussed with reference to the main objective
of the study, which was to investigate Nursing and doctors’ attitude toward patient
safety in emergency departments in multiple hospitals in Jazan, Saudi Arabia.

Discussion:
81% of the participants were nurses and that's the thing to focus on while, the
majority work in Adult ER Department with 69.1%.

First, the results show that the patient waits approximately 0 to 15 minutes for a staff
member to speak to him or her for the first time, which is a very good rate compared
to the national average.

In 90% of the cases, the working staff managed to diagnose the patient's major health
problem before leaving the emergency room.

Second, 86.1% of participants agreed that they describe potential side effects to the
patient in a way they could understand.

The majority of responses for "Overall perception of safety" inclined toward neither
of the options, which is not good because it reveals that patient safety is a problem
at Jazan hospitals, even though it is not serious. The good news is that their systems,
policies, and procedures are successful in preventing errors, with a MEAN=3.4.

Most of the answers to the question "Supervisor/Manager expectations & actions

encouraging patient safety" have a MEAN = 3 with none of the options.

and Organizational learning and continuous improvement, got almost a MEAN= 3.4
with agree choices, which is a great indication for developing and improving the
Organizational learning inside jazan hospitals.

21
Additionally, teamwork within units was quite effective, with a MEAN =3.5, which
indicates that the participants approved of the selections.

The issue was non-punitive response to error, which received a MEAN = 3.3
(agreeing). The staff believe their mistakes are used against them, and when an event
is reported, it seems as though the person is being written up, not the issue, which
makes the staff fear that mistakes they make are kept in their personnel file. Personal
matters must therefore be set aside.

The staffing number was not enough with a MEAN = 2.45, therefore there was work
overload on the staff.

the good thing is a Sense of responsibility toward patients when the work is in crisis
mode, staff tries to do too much, too quickly.

Real support for patient safety was shown by hospitals management, as indicated by
a MEAN of 3.2.

Patient safety is prioritized by hospitals management, who create an environment at

work that fosters it.

But many participants notice that the hospitals management only seems concerned
about patient safety once an unfavorable event with a MEAN = 3.3 occurs.

When there is open communication, staff members feel free to speak out when they
observe something that could adversely affect patient care and to challenge the
judgments or actions of those in positions of more responsibility. with a MEAN of
almost =3.

The hospitals currently appear to be extremely accurate in their feedback and

communications regarding the error and give it high priority. The staff is informed
about errors that occur in this unit and provided feedback about improvements

22
implemented based on event reports to improve their performance, the staff
themselves discuss ways to prevent errors from happening again with MEAN= 3.

Conclusion:
respondents were primarily employed in adult and pediatrics ER Departments. The
dimensions with the highest positive ratings were teamwork within units and
organizational learning and continuous improvement, while those with lowest
ratings included staffing number to handle the workload and patient safety problems
alongside supervisor/manager overlooks patient safety problems that happen over
and over.

The study agrees with (El-Jardali F D. H., 2011), that longer years of experience,
working as a nurse, interacting with patients, and working at a hospital with
accreditation were all linked to a higher overall score.

Last but not least, if hospitals are to increase overall performance and service quality,
they must invest in procedures that boost patient safety. To improve patient safety
practices and culture, a lot of effort needs to be done at the sampled businesses as
well as the region as a whole.

Both the base of organizational structures and instructional programs for healthcare
personnel should incorporate patient safety.

Along with ongoing education, health practitioners required organizational support

in the form of rules, institutions for governance, and reporting.

Patient safety culture assessments in healthcare organizations must be prioritized,

and even more crucially, changes must be made in response to the findings of such
assessments.

23
Some national and international accreditation systems also demand regular
evaluation and reporting of patient safety culture. These evaluations can point out
areas that need improvement, which helps plan focused initiatives that put an
emphasis on enhancing patient safety and overall performance.

In order to identify areas for improvement that hospitals may address to prevent
negative patient outcomes, it should be recognized that evaluating the patient safety
culture is simply the first stage in a lengthy process.

To ascertain whether observable improvements came from executed quality

improvement programs and altered the culture of safety or had an impact on clinical
outcomes, a longitudinal study based on a routine assessment of patient safety
culture is required.

24
References:
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Applying Levers for Change. Parsippany (NJ): IMS Institute for Healthcare
Informatics.

- Al-Ahmadi, T. A. (2009). Measuring Patient Safety Culture in Riyadh's

Hospitals: A Comparison between Public and Private Hospitals. The Journal
of the Egyptian Public Health Association vol. 84,5-6 (2009): 479-500.

- Alzahrani N, J. R.-L. (2019). Safety Attitudes among Doctors and Nurses in

an Emergency Department of an Australian Hospital. Journal of Clinical and
Diagnostic Research.13(4):5–8.

- Centers for Medicare & Medicaid Services, U.S. Department of Health and
Human Services. Emergency Medical Treatment & Labor Act (EMTALA),
1986.

- de Vries EN, R. M. (2008). The incidence and nature of in-hospital adverse

events: a systematic review. BMJ Quality Safety.17(3):216–23.

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in hospitals. BMC Health Serv Res. 11: 45-10.1186/1472-6963-11-45.
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Lebanese hospitals: a study at baseline. Int J Qual Health Care.22 (5): 386-
95. 10.1093/intqhc/mzq047.
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culture: survey results. International Journal of Health Care Quality
Assurance. 2007, 20: 620-632. 10.1108/09526860710822752.

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- Hughes LC, C. Y. (2009). Quality and strength of patient safety climate on
medical-surgical units. Health Care Management Review. Vol. 34, 1:19–28.
pmid:19104261.

- Ikwueme, S. (2018). Assessing Nurses’ Safety Attitudes in Preventing CLABSI

Walden University.

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Health System. 1999, Washington, DC: Institute of Medicine

- Makary MA, D. M. (2016). Medical error-the third leading cause of death in

the US. BMJ (Clinical research ed.),353, i2139.

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Prevention National Hospital ambulatory medical care survey: 2016
emergency department summary tables. Atlanta, GA: U.S: department of
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approach to reducing patient harm at national level. .

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BlackwellReturn.

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value-based approach to reducing patient harm at national level.OECD.

26
 Appendix 1: questionnaire
socio-demographic variables N %
Gender
o Male 37 36.3
o Female 65 63.7
Age
o 25 - 30 23 22.5
o 30 - 35 38 37.3
o 35 - 40 3 29.4
o Older 11 10.8
Your Nationality
o Saudi 86 84.3
o non-Saudi 16 15.7
Your Profession
o Doctor 19 18.6
o Nurse 81 79.4
o Missing 2 2.0
Years in Specialty
o < 6 months 8 7.8
o 6–11 months 2 2.0
o 1–2 years 5 4.9
o 1–2 years 11 10.8
o 5–10 years 26 25.5
o 11–20 years 43 42.2
7 6.9
o > 21 years
ER Department
o Adult 67 65.7
o pediatrics 23 22.5
o Maternity 7 6.9
o Missing 5 4.9
How long does the patient usually wait before you speak to them for the first time?
o 0 -15 minutes 65 63.7
o 16 - 30 minutes 18 17.6
o 31- 60 minutes 7 6.9
o More than 60 minutes 6 5.9
o Don’t know/ Can’t remember 5 4.9
o Missing 1 1.0
Before giving any new medication, did you describe the possible side effects to the patient in a
way that they could understand?

27
 o Yes 87 85.3
o No 14 13.7
o Missing 1 1.0

Before leaving the emergency room, did you diagnose the patient's major health problem?
o Yes 90 88.2
o No 10 9.8
o Missing 2 2.0

Overall perception of safety

Strongly Disagree Neither Agree Strongly
Disagree Agree
It is just by chance that more
serious mistakes do not o o o o o
happen around here
Patient safety is never
sacrificed to get more work o o o o o
done
We have patient safety
problems o o o o o
Our policies and procedures
and systems are effective in o o o o o
preventing errors

Supervisor/Manager expectations & actions promoting patient safety

Strongly Disagree Neither Agree Strongly
Disagree Agree
My supervisor/manager says
a good word when he/she o o o o o
sees a job done according to
established patient safety
procedures
My supervisor/manager
seriously considers staff o o o o o
suggestions for improving
patient safety
Whenever pressure builds
up, my supervisor/manager o o o o o
wants us to work faster,
even if it means taking
shortcuts

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My supervisor/manager
overlooks patient safety o o o o o
problems that happen over
and over

Organizational learning and continuous improvement

Strongly Disagree Neither Agree Strongly
Disagree Agree
We are actively doing things
to improve patient safety o o o o o
Mistake have led to positive
changes here o o o o o
After we make changes to
improve patient safety, we o o o o o
evaluate their effectiveness

Teamwork within units

Strongly Disagree Neither Agree Strongly
Disagree Agree
Staff support one another in
this unit o o o o o
When a lot of work needs
to be done quickly, we work o o o o o
together as a team to get the
work done
In this unit, people treat each
other with respect o o o o o
When members of this unit
get really busy, other o o o o o
members of the same unit
help out

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 Non-punitive response to error
Strongly Disagree Neither Agree Strongly
Disagree Agree
Staff feel like their mistakes
are held against them o o o o o
When an event is reported, it
feels like the person is being o o o o o
written up, not the problem
Staff worry that mistakes
they make are kept in their o o o o o
personnel file

Staffing
Strongly Disagree Neither Agree Strongly
Disagree Agree
We have enough staff to
handle the workload o o o o o
Staff in this unit work longer
hours than is best for patient o o o o o
care
We use agency/temporary
staff than is best for patient o o o o o
care
When the work is in “crisis
mode” we try to do too o o o o o
much, too quickly

Hospital management support for patient safety

Strongly Disagree Neither Agree Strongly
Disagree Agree
Hospital management
provides a work climate that o o o o o
promotes patient safety
The actions of hospital
management show that o o o o o
patient safety is a top
priority
Hospital management seems
interested in patient safety o o o o o
only after an adverse event
happens

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 Communication openness
Strongly Disagree Neither Agree Strongly
Disagree Agree
Staff will freely speak up if
they see something that may o o o o o
negatively affect patient care
Staff feel free to question
the decisions or actions of o o o o o
those with more authority
Staff are afraid to ask
questions when something o o o o o
does not feel right

Feedback and communications about error

Strongly Disagree Neither Agree Strongly
Disagree Agree
We are given feedback
about changes put into place o o o o o
based on event reports
We are informed about
errors that happen in this o o o o o
unit
In this unit, we discuss ways
to prevent errors from o o o o o
happening again

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